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Implants—Then and Now – Huh?

March 23, 2015

Filed under: Business of Dentistry — Tags: — Barry @ 12:36 PM

Screen shot 2015-03-16 at 12.36.12 PM Screen shot 2015-03-16 at 12.36.24 PM


It’s a tragedy when a person has to lose all of their teeth.  Sadly, there are many people who eventually have to face that situation.  There was a time when all of our efforts were directed toward prevention and keeping teeth.  That is is till the philosophy of most of us in dentistry, but due to circumstances many people still lose their teeth.

Economics plays a role these days.

Lucky for most of us we have a great solution: implants.

As they say, “We’ve come a long way baby.”

When implants first came to dentistry we were sort of limited in what we could do, but dentistry has figured out many ways to design implant cases so that today’s solutions are better than ever.  In the early days that wasn’t always true.

Take a look at Jim.  He had 8 implants placed twelve years ago.  On top of the implants, the dentist created a bar that was secured to the implants with eight individual two piece abutments.  That bar was screwed into place and a removable denture was placed on the bar...yes! I said removable denture.

Let’s take a time out.

Even twelve years ago the thought of implants meant teeth that stayed in the mouth.  That was and is the biggest selling point for implants.

So Jim had a removable denture secured on eight implants, using 27 components.

We’ve come a long way, baby (LOL).

Some years later the denture didn’t feel quite as secure as it did on day one.  As a fix the dentist placed those two little anchors that are sticking out of the photo on the bottom.

It never worked.

So Jim came to see us.  Our challenge was to give Jim a fixed restoration.  We didn’t need all 8 implants, but for the sake of not being wasteful we tried to use all of them.  Our goal—to make a fixed denture and reduce the components from 27 to 9.

The photo on the right is the result.

Difficult case?  Yes…lots of transfers and putting pieces together.  At the end of the day Jim was happy.

In all my years of practice I don’t think I ever had a happier patient.  For the first time in twelve years he could eat and not worry about his teeth coming out.

I know that sounds like some BS the denture adhesive ads tell us…but this is real.

After treatment he handed me a gift certificate to a local high-end steakhouse.  In retrospect, I should have treated him to the steak.


GOALS ! A New Look

March 10, 2015

Filed under: Art of the Examination,Self-development — Tags: , , , — Barry @ 10:58 AM




We all know how important it is to set goals, don’t we?  From the day I began practice, everyone advised me to set production and collection goals, after all goal setting makes perfect business sense.

In the late eighties I was enrolled in a so-called “business school for dentists” with the main focus on establishing monthly production goals.

Everyone on staff was focused on production.  We set SMART goals.  SMART is an acronym for specific, measurable, attainable, realistic and timely.  We set up bonus systems when goals were reached.  As time went on we really turned up the heat by setting big “stretch goals.”

But then I noticed something happening: we kept raising the bar until we achieved some unintended consequences.
Goal setting is the standard of operations in the business world.  There is a popular study that is cited from the 1979 Harvard Business School MBA program in which 3 percent of the students wrote down their future goals.  Ten years later that 3 percent of students were worth ten times the worth of the rest of the class combined.

This study never occurred…it is pure urban myth.  Today that myth is being totally exposed by studies that reveal the downside of goal setting.  According to a new study from the Harvard Business School, titled “Goals Gone Wild,” there are many side  effects from goal setting including:

•    Too narrow a focus that neglects non-goal areas.
•    A rise in unethical behavior.
•    Distorted risk preferences.
•    Corrosion of organizational culture.
•    Reduced intrinsic motivation.

These studies confirmed what I was feeling during the eighties.

I am a big fan of building culture, and when our entire culture centered around production I became uncomfortable.  Although I don’t remember compromising my ethics, I certainly saw the possibilities.  I am a big fan of the importance of intrinsic motivation to our well-being.  My focus on the extrinsic rewards were the reason I sought guidance burnout years ago.  This obsessive desire to focus on extrinsic rewards ended up being the cause of my unhappiness in dentistry.

So what did I do?  I turned it around…I focused on process over product.

I still had an idea of a specific result I wanted to see each month, but I focused more on how to get there.  In other words, I identified areas of focus that would get me that destination if I diligently applied myself.  This was how I developed and committed to my master systems of examination and case presentation.

These two processes are not even “productive,” but they give us the capability to produce more dentistry.  Pretty counter-intuitive.
Author Peter Bregman in his new book 4 Seconds, says, “A goal is a result; an area of focus is a path.  A goal points to a future you intend to reach; an area of focus settles you into the present.”
When I concentrated more on examination, diagnosis, treatment planning and communication, everything changed.

What we pay attention to is what gets rewarded.  We become better, and build a better culture when we take our eyes off of production goals.
Not only will the dentists reach his destination but in the process he or she will become better dentists.  The culture will be built around the process instead of the targets.

Through repetition we can get better at preps and impressions but what about the skills that really matter, the ones that make or break the success of a dentist…the non-technical skills…the soft skills.
By slowing down my exam process I was able to see how poorly I was doing at certain things, how well I did at others, what needed improvement and what made the biggest differences.  In other words, the exam process is a compilation of many key skills that matter.
Legendary basketball coach John Wooden understood the role of extrinsic goals.   Wooden held his drills without a basketball in the player’s hands.
Why?  Because the ball tempted the players to take a shot—and not work on the drill.  Scoring was so tempting.  John Wooden called the basketball “catnip.”  Production and collection are the dentist’s catnip.
But the goal is to win…to score a lot and grow.   As long as the catnip is present we will never slow down enough to practice those sweet soft skills.

The Path of Most Resistance – Key to Goal Setting

January 13, 2015

Filed under: Business of Dentistry,Self-development — Tags: — Barry @ 10:59 AM

yoga pose photo




January 10, 2015.  The second Saturday of the New Year and my 8 AM Bikram Yoga class is way too overcrowded.  It happens every year.  January always shows an increase in attendance at Yoga, gyms and Weight Watchers.  “It’s okay,” I tell myself, all will be back to normal by February.  Leo the Sage tells us to set a yoga goal this year.  I think to myself, “I set that goal four years ago…I need a new goal for this year.”

Later on I tell Leo, “It won’t work, human nature will take over, they’ll be gone…something will stop them, I’m a dentist, I know all about objections.”

Fear, money, time, procrastination.  The list goes on, but it’s all about resistance.  Resistance is the enemy and resistance essentially is fear.

During Leo’s rap (he never stays on script, that’s what makes him a sage.), I hear references to so many other things beyond Yoga.  I wish all the dental lecturers would slip in some good self-help in their lectures, but that will never happen.

During the second posture I hear Leo say, “Pulling is the object of stretching.”  I think about my other goals…like writing this blog post, or the book I promised myself to write this year.  That’s what writing feels like sometimes, pulling.

Yoga is easy I think, it’s been four years…three days per week.  It’s become a habit, like my examination process.  But writing and meditating, those are my demons.

The blog post…easy peasy…the book, that’s a stretch goal.

“Pulling is the object of stretching.”

A few postures later, the standing bow pose, one of the more difficult balancing poses, Leo tells us, “Go ahead, fall out…but get back in.”  I think about all the times I have fallen out…and got back in.  That’s the key…the getting back in.  So many people are too worried about the falling out part.

Once the fear comes…just breath…slow down the heart rate.  I think to myself, “I didn’t write yesterday…get back in that chair today.”

“If you fall, get back in.”

When we do the fixed firm posture, a severe back bend, I feel proud because this is one posture I have had a lot of success with over the past four years.  I remember when I could barely go back 20 degrees.  Now I can can place my head to to floor…not perfect but pretty damn good for an old man.  Many of the new kids on the block can’t do it…they’re 20 degree-ers.  Leo tells them to just go where they can’t go anymore…”go to your edge…feel the resistance.”

I laugh…because I have been there.  So many are afraid of the resistance.  They back off.  They would be surprised to know how far they really could go.

” Go to the edge…feel the resistance.”

The resistance is your friend.

Psychologist and goal expert Heidi Halvoson tells us:
“We are often reluctant to set very meaningful, difficult goals for ourselves. But well over 1000 studies show that when people set difficult and specific goals for themselves, they are vastly more successful and vastly more satisfied and happy with their lives than when they just say ‘well, I’m going to do my best'”.
 Fear comes in many different forms.  The first step is to recognize it for what it it…and then meet it and slay it.  Here are some examples and things one might say in a Yoga class:
  1. Fear of failure – I can’t do Yoga, I’m not flexible enough.  One might also say… I can’t meditate, my mind wanders, or I can’t write, (speak in public).
  2. Fear of embarrassment – I look like a fool doing this stuff…I’ll never be as good as that young girl.
  3. Fear of losing control – like passing out in class?  Ooh, how embarrassing.  In four years, I never saw that happen, and I’ve been in some pretty hot rooms.
  4. Fear of rejection – All classes are beginner’s classes—after four years, I’m a beginner.  Once you think you’ve arrived, you already begun your descent.
  5. Fear of confrontation — confront who? you say.  Confronting yourself…the biggest obstacle.
  6. Fear of isolation – Joe Campbell once said of all heroes—when you reach your goal—you thought you would be alone, but you are one with all the world.
  7. Fear of change – ahh the good old comfort zone.

I think about three words all the time…destiny, innovation and change.  The world is always changing, and we must change with it.

See how much you can learn in just one Saturday morning Yoga class?





Defend Yourself Against Bad Reviews

December 3, 2014

Filed under: Business of Dentistry — Tags: , , , — Barry @ 10:51 PM

negative+reviewYou have to have a strong stomach to check yourself out on Yelp or some of the other review sites that have become so popular in this digital age.  I recently visited a few sites to see what people were saying about me…and boy, was I surprised.

Now I will say that I have a massive number of positive reviews gathered through the years but sitting right on top were two very stinging reviews…that made me quiver when I read them.  Who knew?

In defense of one, it was written by a dentist/patient who had become a real pain in the you-know-what.  I knew him from my gym and he came in as a patient.  He constantly told me how to do my job until I got sick and tired of him.  His response: to write a scathing review on a few online sites.  My initial response was to ignore.

The second review stung a bit more because it was by a patient who I had made complete dentures for, over one year ago.  She said I was a nice enough guy, but the teeth were terrible and now she goes around toothless, because I didn’t know what I was doing.  I remember her as a polite woman who rarely came in for adjustments.  Then I find out how she really felt.

I scrolled down to see if there were others.  Sure enough I found various words like insensitive, expensive and even dictatorial.

All of these were buried in a sea of really good reviews.

So how should I feel?  There is an old saying:

One thousand compliments = 1 insult.

I love Paul Simon, and when I read the reviews I kept hearing his tune, Something So Right, in my head:

When something goes wrong
I’m the first to admit it
I’m the first to admit it
But the last one to know
When something goes right
Oh, it’s likely to lose me
It’s apt to confuse me
It’s such an unusual sight
Oh, I can’t, I can’t get used to something so right
Something so right

In other words having a “negative bias” is just one of the flaws of being human.  Is this the plight of so many dentists?  Or how about other small business owners like barbers and restaurant owners?

Should we care about this online nonsense?  Many small business owners say they ignore it…but they shouldn’t, because in today’s world 80% of people base their buying decisions on reviews.

Taking a positive spin on bad reviews can actually help your business.

Bill Tancer, author of the book, Everyone’s a Critic, advises small business owners to chill out because “bad reviews will happen.”  Don’t we all get suspicious these days when there are 100% positive reviews?  A bad review, here and there, can actually add credibility.  Even best selling authors like John Grisham get bad reviews, and hey, not everyone loved The Godfather.

Another point Tancer makes is that sometimes the bad reviews force you to take a look in the mirror.  Sometimes the criticism is valid, and if you use the review as data then that’s a first step in improving your business.  Sometimes you have to pay exorbitant consulting fees to find out what our angry patients are willing to tell us for free.

Reviews, good and bad are not going to go away.  The future will be more rather than less dependency on reviews and review sites.  Hopefully, as the Internet evolves there will be more fairness in terms of “bilateral reviews,” a place where the business owner can respond without sounding like sour grapes.

Until then, it’s all about freedom of speech.  Reviews can’t be suppressed.  We can drive positive reviews as many of us do, and I feel that is our best strategy at the moment.

One last little story.  I was reading my reviews and found one from a temporary dental assistant.  She obviously didn’t like me, and she used the review site to tell the world what a jerk I was.  I have no idea who she was…I remembered none of it.  Either I was having a bad day or the agency sent me a real loser (I know most dentists will guess the latter).  Anyway, I called the agency and told them that if they didn’t put a stop to that method of feedback I wouldn’t use them anymore…the owner immediately went to the site and wrote the nicest review for me that contraindicated the one written by the miffed assistant.

There are things we can do…we too have freedom of speech


The Game of Dentistry—and Blackjack

September 8, 2014

Filed under: Business of Dentistry,Self-development — Tags: , , — Barry @ 12:05 PM


The day after Labor Day…the unofficial start of the new year.  The Tuesday after Labor Day has always been my New Year’s Day and I haven’t been in school since 1973.  I left the beach in St. Maarten on Sunday, where I made my yearly goals, read a few good books, worked on my tan and played a lot of blackjack.

I read Doctored, The Disillusionment of the American Physician by Sandeep Jauhar.  It’s a good read, and I highly recommend it for all health care professionals who are concerned with the changing nature of health care delivery in America.  I related.  I feel it should be required reading for younger dentists who are facing the long career.  It’s about the ups and downs of balancing a life in medicine between creating a good lifestyle and being a good doctor.

Jauhar struggles with providing his patients with the best care while earning a good living during his early years when his responsibilities at home are demanding more time.

I felt his pain…especially since the recession hit and third parties began to flex their muscles.

In case you don’t know, I’m all about the private practice of dentistry...what they now refer to as fee-for-service dentistry.  There was a time when we didn’t make that distinction.  A time where you just went to work and focused on your dentistry without interferences.  Today, in order to maintain and sustain a fee-for-service practice the dentist must have an approach…a philosophy if you will.  Jauhar writes about taking control of the two things that you can…mastering your craft and controlling relationships.  It’s funny, but that is essentially what this blog is about…controlling relationships as best as you can through trust, appreciation and ownership and providing excellent care through complete dentistry.

The book was very helpful…especially when I got to the blackjack tables at night.  Because life is a little like blackjack.

Let me explain.  Blackjack, like life is not very complicated.  It has rules, and if you know them and don’t stray too far from the guidelines you’ll be a winner…in the long run (those are key words).

The game is set up so the dealer or the house has a very slight advantage.  That means that if you play, for arguments sake, one thousand hands, the dealer will win approximately 510 of them and you will lose 490.

The dealer plays by the rules—she never waivers…no emotion.  The dealer also gets relief every 40 minutes so they never get tired.  They do deserve the slight edge because after all it’s their house…and they serve free drinks.

That kind of control is available to the player as well.  Play right (master the craft) and control the quantity of the individual bet.  That’s all you need to know.

You see out of those 490 wins that every player will get they don’t alternate between the player and the dealer.  Many times there are streaks.  Imagine that a streak started that lasted 10 hands…and the player kept increasing the best (called pressing the bet), well I can tell you that winning, and winning big is now in the player’s future.

When that train slows down and the streak goes to the dealer…then revert to the minimum bet.  Of course the player must play the game correctly.

The vast majority of blackjack players lose…even those who play right…who know what the “book” says.

Why?  Emotions and energy.

Let’s take energy first.  You have to be prepared to play blackjack…if you to be able to last.  That means don’t show up to a $25 table with $100.  No one can sustain a losing streak…you need excess energy (cash).  Just like practice, you need to show up everyday with excess energy…mental, physical and emotional.  That’s what all the self-improvement stuff is all about.  That’s what makes sustaining a dental practice difficult.  No one particular case, but the entire population of patients we see that visit us with difficult technical problems.  It’s the emotional issues that wear down most dentists.  Be prepared.  Not everyday is going to be a holiday.

And how about emotions?  I can’t tell you haw many blackjack players get blown out because they don’t exercise discipline and consistency.  Listen…here’s what the book says…player hits on 16 when the dealer has a 10 or picture showing.


That situation occurs a lot…and yet I see most players get nervous (fear) when it comes up.  Mostly, they stick…and sometimes they win…but mostly they lose.  When asked, they say they hope the dealer is going to bust and they are afraid to bust.

Huh?  The dealer has a 10— the odds are they can’t beat the dealer with their weak 16…and by the way, hope is not a strategy.

People live their lives the same way, with fear.  Or they take unnecessary risks…like betting the house on one hand.  They go for broke…even after playing a disciplined game…they go all in.

Stay consistent, follow the rules, manage your energy and relationships…it’s they keys to blackjack, and most games…after all life is a game.





By-Products of an Examination Process

February 17, 2014

Cover of "The Checklist Manifesto: How to...



By far the most important lesson I ever learned in dentistry…one that I wrote a book about…and one that changed my life even more outside the profession than within the profession…was to commit to a comprehensive examination process.   For that I thank my mentors Peter Dawson and Irwin Becker.  That one change in my philosophy lead to the creation of more positive habits, more consistency in behavior and more success than anything else I ever applied.   That’s a bold statement, but if you have committed to a comprehensive exam process then you know how true it can be.   One of the advantages of doing a consistent, comprehensive examination on every patient is that it reduces the number of errors we make in treatment planning our patients.  Make no mistake— planning treatment for patients…all patients…is the most difficult thing we do in dentistry.   Why?   Because regardless of the eventual treatment, we are doing it on the most complex system ever created — the human body…both the physical component and the mental/emotional component.  Dentistry and medicine are complex fields if only because of who we work on – people, not machines.   And so many dentists…and those who have a lot to say about health care in this county – devalue it.   Why?  I’ll let you answer that because the number of reasons is equal to the number of dentists who don’t do it.  That alone is a good reason to do an exam on every patient.   Some years ago I wrote about and praised the book, The Checklist Manifesto by Atul Gawande.  I still recommend it.  In that book I compared his “checklists” to our examination process.  He wrote about complex situations like what goes on in the operating room and in preparing airplanes for travel.  Of course these situations can be a matter of life and death…but that doesn’t reduce their meaning for what we do in our everyday lives.  Checklists lead to better predictability and control.  Is there a goal you haven’t been able to achieve?   In a new book, The Upside of Down, author Megan McArdle refers to Gawande’s book in an effort to explain how to reduce errors by creating a checklist/process.  She reminded me of a quote I once read by W. Edwards Deming:

“If you can’t describe what you are doing as a process, you don’t know what you are doing.”

I firmly believe this, because the examination process for me was the starting point for understanding everything I know about this field.   McArdle then cited University of Penn sociologist Charles Bosk who studied types of errors we make.  His work focused on medical mistakes. This is where it gets interesting.   Bosk classified four types of errors:

  • Technical errors.  These would include things like the drill slipping…these things do happen.
  • Judgement errors.  Includes errors of waiting too long to treat or using questionable techniques.

Both of those types of errors occur with some frequency and although I hate to say it…are expected.  Into everyone’s life a little rain falls.   The next two types are not expected and this is where taking the proper precautions and using a process can keep us on the straight and narrow,

  • Normative errors – or failing to get and use all of the information that is available about a patient.  This one calls into question the personal fitness of the doctor.  This is why dental schools taught us why cheating was so bad.  These are the ethical errors.
  • Quasi-normative errors – these are the ones that dentists do because someone suggested that they do it.  Hmm…who might that someone be?  I call this the Flip Wilson error…the late comedian who became famous for saying “the devil made me do it.”

So why do these last two types of errors occur?  It’s easy to blame people, but if you could build fail-safes into your process, then it’s more likely you will avoid these errors.  No guarantees, but what McArdle says makes sense:

“People who commit normative errors are generally too focused on outcome and result, and not enough process.  They are willing to cut corners, to bend rules, and that is a very dangerous thing.”

So the lesson is,  if you want to minimize the risk of catastrophe, you focus on the process much more than the outcome.   But there’s more.  The examination process even beyond dentistry, helps us understand ourselves better.  It can be a self-development tool…it was for me.  Remember what Socrates said, “The unexamined life is not worth living.”   And he wasn’t talking about teeth.

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Get Out of the Comfort Zone

January 6, 2014

Filed under: Business of Dentistry,Self-development — Tags: , — Barry @ 10:30 PM



On Friday morning January 3rd, 2014, I woke up to the first snowstorm of the year.  Six inches covered the ground and would be a big obstacle for me to get to my 9:30 hot yoga class.  I could feel the resistance that pressed against my covers, but I pushed them off and began my ritual of showering and drinking 72 oz. of water.  Then I checked the web to see if the class was cancelled…Luckily for my bladder, the class was on.

I live in the woods.  The plows never come down my road…it’s dirt and gravel, so I had to mash my way through the snow to get to the class.  When I arrived I was met by four other hearty souls and the teacher.

The reward:  the best hot yoga class ever—and the heat felt sooo good.

That’s usually the payoff for breaking through resistance.

We face resistance everyday of our lives.  We have this preference for comfort and low stress.  Yet, as I always say, “The insecure path is the secure path in the end.”

Just last week I started a complex restorative case involving ten upper teeth.  The case included an implant, several veneers and crowns, and some pink porcelain.  My patient traveled over three hours for the appointment.  I worked slow and methodically to get all of the information required for the case.

I checked the impression and was pleased that I captured every margin.  I placed the temporaries and sent my patient on his way home.  An hour later, my son Josh who is also my lab technician, informed me that I would have to retake the impression.

“Why?”  I asked.

He said although the margins were great, because we would be using refractory dies that the pulls in the non-strategic areas would not allow him to get accurate dies.  I would have to call the patient back for another impression.

I felt resistance.

My patient would have to take another day off from work, drive six more hours, have his temps removed and have another impression…yes,with local anesthesia.

I felt resistance.

I didn’t want to make that call...yet I was the only one who could make that call.

So I did, and he totally understood.  He wants the case to come out as perfect as possible.  I felt better having broken through the resistance.

Everyday, no matter what line of work we are in or no matter what goals we set for ourselves, we will meet resistance.  When you feel that uncomfortable sensation in your gut, that’s resistance.  Telling you to stay put.  In your comfort zone.

Pushing through is the key to success.  So as we begin this new year…if you have made resolutions, realize that you should still being going to the gym in April…and along the way you will feel lots of resistance.



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Dentistry Been Very Good to Me

December 3, 2013

Filed under: Article,Business of Dentistry — Tags: , , , — Barry @ 10:21 PM



Sitting in a Barnes & Noble just chilling out after a hot yoga class and looking through one of John Wooden’s leadership books.  

I come across a lesson that reads:

“If you don’t have time to do it right the first time, how will you find the time to do it again?”

My mind wandered to where I originally heard that old piece of advice.  It was repeated over and over again in dental school…over 40 years ago.  I still use that advice in my practice and daily life.  Good thoughts from the old coach.

I took out my iPhone and posted on Facebook under the heading of Dental School Wisdom.  Within minutes there were a whole slew of responses.  The problem was that no one was responding to the Wooden quote, just to the phrase “Dental School Wisdom.”

It was as if I had just said the magic words like Niagara Falls in that old Abbott and Costello skit.  If you never saw the skit it’s worth watching and you will appreciate the emotional response I got toward people’s dental school experiences.

I was severely outnumbered.  I had a great dental school experience.  Some of the best years of my life.  Maybe it was the time, late sixties to early seventies, but I felt no pressure, and I wasn’t some sort of child prodigy.  Compared to what came before it, I thought it was a piece of cake.  After all when I finished I would get the prize…a license to practice that would enable me to have a great life.  I felt fortunate…still do.

But obviously, after reading the responses, I was in the minority.

It seems that dental school bashing is all the rage these days.  Whatever happened to gratitude?  While reading the comment thread I was reminded of a blog post written a couple of years ago on the Lolabees Blog.  It was called 10 Reasons Why I Hated Dental School.

That blog post produced a ton of comments that supported the “I hated dental school theme.”  What was I missing?

I follow Lolabees blog and noticed through the years that her blog posts attract many people who seem to want to leave dentistry.

Is there something inherently wrong with this profession?  Did I miss an important meeting?

Sure I would have loved to play third base for the Phillies, but Mike Schmidt was a smidge better than me.  Look I don’t apologize for liking dental school or actually enjoying the fruits of of last forty years of labor in a field that I had total control over.

But as an author and an educator—it bothers me that so much bashing is going on when I know there is nothing inherently wrong with dentistry.

So stop complaining!

Then, in a dream one night, the word Millennial kept flashing in my mind.

I’m a Baby Boomer.  I come from a generation where a job meant something different than it does to today’s young people.  Millennials would prefer meaning over money…and so they change jobs more often.  My generation was satisfied in finding a job that provided a good life and we stayed with it forever.

When I looked at the bashing from that point of view I softened my outlook.

You see…I am very sensitive about doing meaningful work.  I spent the last forty years creating conditions that afford me the freedom to do meaningful, and important dentistry…dentistry with purpose.  Basically that is what my two books are about.

It’s tougher to do that these days.  But if you are willing to create that opportunity…it’s still there, and the grass is still not greener.

The one problem that I see is that of all the attributes needed for a purpose driven dental career...self-esteem is number one.

I have to admit that even forty years ago…my self esteem was tested in dental school.  But I am not one to give the advice to just “buck up and take it.”

No, dental education has to improve— dental schools must build their students up rather than tearing them down and destroying confidence.  Maybe I was lucky.  Maybe I was just born at the right time.  Either way—if dentistry is going to survive as a profession, the dental schools must reform.













Focus on Function

November 25, 2013

Filed under: Business of Dentistry,Philosophy — Tags: , , — Barry @ 1:18 PM

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When I speak I tell dentists that their patients come to them for four reasons: health, comfort, function and esthetics.  That’s today, but the profession has evolved into that position.  I am sure that the very first dental patient sought treatment for pain (comfort).  That particular type of patient probably dominated the dental landscape for the majority of history…at least before George Washington’s wooden teeth.

Modern times brought more and more patients seeking treatment for the other reasons listed above, but right through the days of Doc Holliday and Dodge City, and Painless Parker, the main reason was for relief of pain.  Then somewhere in the late 19th Century and early 20th Century, dentistry became legitimatized with the advent of the the American Dental Association and an organized system of dental education.  Dentists became doctors—and health and saving teeth was added to reasons people sought treatment.

But “health” is a vague term that means different things to different people.   To many it means keeping teeth for a lifetime.  Certainly a worthy goal, that requires quite a bit of attention to not only teeth but to gums as well as to bites.  My feeling is that too many dentists and even dental educators fail to describe what real health is.  But the focus on dentistry has been “health” for many years.


A new focus on cosmetics replaced comfort and health.  The “Cosmetic Revolution” started in the mid-nineties and it remains today as the focus of dentistry for many doctors and patients.  For other dentists it has become a distraction to the “health” issue and helping patients keep their teeth for their whole lives.

I agree that comfort, health and esthetics are very important goals for any dental practice—but as my practice evolved over the last forty years and my patients have gotten older, I have found a new perspective on the fourth reason…function.

Dental disease is chronic disease.  Not as life-mandating as heart disease, diabetes or cancer — but chronic, preventable disease, that if left alone will cause the body to break down and threaten quality of life and longevity.

Lately, I have been treating a significant number of nonagenarians (those lucky enough to reach the age of ninety).  For these patients, optimal health and esthetics take a back seat to loss of function.  It’s a whole new ballgame when these patients have to alter the way their bodies worked for so many years.

Even at my spry age of 66, the most important thing in my life is to wake up every morning and have everything working properly.  The old cliche’ about flossing only the teeth you want to keep, takes on new meaning when you look at it through the lens of function.

Norman Mailer wrote the Pulitzer Prize winning book, The Executioner’s Song, about serial killer Gary Gilmore.  Notably, the thing that Gilmore regretted more than anything was that he had no teeth to eat his last meal consisting of steak, potatoes, milk and coffee.  He only had the milk and coffee.

I hope I don’t sound too morbid, but I have learned to live better by trying to understand how I will make my final exit.

My elderly patients teach me that everyday. 

 In my book The Art of Case Presentation I refer to my friend Dr. Ken Myers of Portland Maine.  Some years ago he started his 80/20 Club.  In order to become a member, the patient had to be at least 80 years old and still have 20 natural teeth.  When I see photos of the club that they take at yearly luncheons, I am always impressed by how vibrant and happy they look.

Some years ago I read an excellent article by Dr. Atul Gawande, about frailty and the elderly.  Gawande, the author of The Checklist Manifesto is an excellent writer who has a very good handle on healthcare in America.  His philosophies have changed the way I think about health…and dental practice.

He describes frailty as a loss of function.  Some of it comes with natural aging…but some can be prevented…

with a focus on function.








How Dentists Lost Dentistry

October 16, 2013

Filed under: Business of Dentistry — Tags: , , , — Barry @ 1:12 PM

Friends having having a drink in a bar-784467


I recently attended the 2013 Pankey Alumni Meeting in Orlando Florida.  One night, while sitting around the bar with fellow alumni members, throwing back a few, I realized that after all these years our practices had evolved similarly.

All very different but quite similar.

I began to reminisce about the first time I went to the Pankey Institute.  It was the late eighties and I was at the lowest point in my dental career.  After fifteen years of practicing without a clue…I was ready to be saved.  What I learned was a way of doing dentistry that covered not only technical dentistry, but the business of dentistry and the behavioral components as well.

Dentistry is about way more than tools and techniques.  As a practicing dentist, an educator a coach and an owner of a dental laboratory, I find most dentists run into problems because they over-emphasize the technical component.

Meanwhile…back at the Alumni Meeting…one of Pankey’s elders, an original cadre member made a speech.  He said, “The Pankey philosophy is needed now more than ever.”

I disagree.  What is needed now more than ever is a philosophy…any philosophy, that teaches dentists a way to work their way through this incredibly complex field of technical dentistry, human behavior, business ethics, sales and marketing…in an ever changing world.

Honestly, I got lucky.  I could have continued to learn more and more fragmented technical courses without any sense of coherence.

Back then there weren’t many choices—today there are many institutions that offer a continuum of philosophical dentistry.  Many dentists have benefited from taking their programs.

But too many have not — and that is a problem.

Dental schools do not prepare dentists for the real world (an ever changing domain).  Today’s young dentists do not have the same opportunities that were available years ago.  Their student loans are higher and the cost of opening their own practices have skyrocketed. 

Between those obligations and an enormous amount to learn…they are looking for other options.

Dentists are doing more marketing than ever before.  Dentists are joining insurance plans in order to get new patients and fill their chairs.  Dentists are joining DSOs (dental service organizations-aka corporate dentistry).

Along the way dentists are losing their autonomy.  Some would argue that we always have our freedom of choice, and that is true, but to exercise it takes a lot more “philosophical training.”

Someone once told me that philosophy was a tough sell.  And I might agree…What?  Do we really need Aristotle?

But if Aristotle were alive in the nineteenth century he would have been William James—a psychologist, and if he were alive today he would be Anthony Robbins…a lifestyle coach.

After all he did train Alexander to become great.

The paradigm for how dentistry is delivered has changed.  There is no going back.

As the Affordable Care Act and DSO’s  become prominent, only those dentists who understand the complete concept of dentistry will survive with their autonomy.

And the philosophy teachers?  That role will be filled by government and corporate dentistry.  They will tell dentists how to practice.  They will take over all of the other domains that we used to call philosophy.  They will infuse the practice of dentistry with their mission…their vision and their purpose.

There are plenty of advantages of the old way of doing dentistry.  Everyone preserved their freedom of choice,  Dentists, as much as people would disagree, had to have the patient’s best interests at heart in order to survive…their goal was to help people keep their teeth rather than just watching numbers and bottom lines.

That’s how dentists have lost dentistry…by not paying attention to learning a “way” to practice. 

That is also how I came to sit at a bar with dentists who all practice very similarly…yet differently.








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